title: Mitral valve repair versus replacement for moderate-to-severe mitral regurgitation in patients undergoing concomitant aortic valve replacement.
abstract: OBJECTIVE
  Whether to repair or replace the mitral valve for patients with significant mitral regurgitation undergoing aortic valve replacement is still controversial.
  
  
  METHODS
  From January 1990 to December 2011, a total of 663 patients underwent aortic valve replacement combined with mitral valve surgery. Among these, 253 patients (mean age 55.9 ± 14.5 years, 91 females) with moderate-to-severe mitral regurgitation were enrolled to compare the outcomes between double valve replacement (DVR group, n = 158) and aortic valve replacement plus mitral valve repair (AVR plus MVr group, n = 95). Survival and valve-related events were compared by the inverse-probability-treatment-weighted method using propensity scores to reduce treatment selection bias.
  
  
  RESULTS
  Early mortality was similar between the groups (1.9% in the DVR group when compared with 3.2% in the AVR plus MVr group, P = 0.55). During the mean follow-up period of 72.1 ± 56.7 months, 45 patients died (28 in DVR and 17 in AVR plus MVr) and 31 experienced valve-related events including valve reoperation in 11, anticoagulation-related bleeding in 14, thromboembolism complications in 9 and infective endocarditis in 3. After adjustment for baseline risk profiles, the DVR group showed no difference with regard to risks of death (hazard ratio [HR], 1.79; 95% confidence interval [CI], 0.79-4.01; P = 0.16) and valve-related events (HR, 1.15; 95% CI, 0.40-3.30; P = 0.80) compared with the AVR plus MVr group.
  
  
  CONCLUSIONS
  Although the outcomes of either mitral valve repair or replacement for moderate-to-severe mitral regurgitation in patients undergoing concomitant aortic valve replacement show no statistical significance in terms of long-term survival and valve-related event rates, DVR seems more hazardous than AVR plus MVr based on the estimated HR in terms of survival.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Gwan Sic
authors.initials: GS
authors.lastname: Kim
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.forename: Seungbong
authors.initials: S
authors.lastname: Han
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D057216:Propensity Score; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic valve; Mitral valve; Repair; Replacement